Health-care cost rising fast

In the very near future, Canadian Medicare will consume 50 per cent of every hard-earned taxpayer dollar we collect. That is, unless we wake up soon and realize that we cannot afford to keep spending this much on health care.

We will have to raise taxes, cut services, learn to live with longer and longer wait times and forego necessary expenditures on education, policing, infrastructure renewal, defense, social services. On the other hand, we could pull our heads out of the sand, wrest control from our politicians and bureaucrats and demand that our healthcare system be managed more effectively.

In her recent book, “Better Now”, Dr. Danielle Martin proposes six ideas that, collectively, would be a good start to meaningful health care reform in Canada. They are:

1. Ensure relationship-based primary health care for every Canadian

2. Administer prescription drugs under Medicare

3. Reduce unnecessary tests and interventions

4. Reorganize health care delivery to reduce wait times and improve quality

5. Implement a basic income guarantee [poverty is the prime determinant of health].

6. Implement successful solutions across the country. No more innovative local pilot projects dying on the vine.

Last winter a concerned group of healthcare experts challenged the Nova Scotia Health Authority to significantly change the way it manages health care. Their suggestions seem eminently applicable to the rest of the country. [https://nshealthcaresolution.wordpress.com]

Most politicians do not have in-depth knowledge about health care and should not be expected to provide solutions to complex, interconnected healthcare system processes. The body that oversees health delivery must operate independently, at arm’s length from the government. Governance matters. The board of directors and senior managers of NSHA need to have authority, decision-making power and be accountable and transparent. Failure to manage effectively should have real consequences, for both managers and health professionals, as it does in the rest of the business world. The role of elected officials, and the civil service which supports them, is to set broad objectives and benchmarks; then they should get out of the way and let the system be run by professional managers who are agile, competent, aggressive, anticipatory and ‘think globally, act locally.’ There must be a degree of regional autonomy. Almost every province has vacillated between centralized and decentralized organizational structure. Payroll and purchasing are best done centrally, but care must be delivered in a way that is adapted to local needs. We must leverage purchasing power and standardize medical equipment by streamlining procurement and supply management.

There need to be checks and balances from within and outside the system. An inter-professional clinical advisory group to the Board should be created. It is essential that patients have a strong voice, too, one that extends well beyond having token seats on committees; Measurement matters: We must have clear-headed analysis of implemented changes in order to figure out what works or doesn’t work. Give professional managers the tools they need to do the job properly.

With resolve there comes hope. In the words of Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

Desmond Colohan is a semi-retired Island physician with a keen interest in responsible public policy.